Form the Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Rd, Guangzhou, Guangdong 510630, China (K.Z., J.C., X.M., B.Z., W.H., M.C., H.S.); and Department of Radiology, Guangzhou First Municipal People's Hospital, Guangzhou, Guangdong, China (L.L.).
Radiology. 2014 Jul;272(1):284-93. doi: 10.1148/radiol.14131946. Epub 2014 Apr 6.
To determine the safety and efficacy of transarterial chemoembolization (TACE) combined with sorafenib (hereafter, TACE-sorafenib) in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT).
This study was approved by the institutional review board, and the requirement for informed consent was waived. The medical records of consecutive patients with HCC and PVTT who underwent TACE-sorafenib or TACE alone from January 2010 to December 2012 were retrospectively evaluated. Sorafenib (400 mg) was administered twice daily. Outcomes of patients who underwent TACE-sorafenib were compared with outcomes of patients who underwent TACE by using the Kaplan-Meier method according to types of PVTT: PVTT in the main portal vein (type A), PVTT in the first-order portal vein branch (type B), and PVTT in second- or lower-order portal vein branches (type C).
Ninety-one patients were included in the analysis; 46 patients underwent TACE-sorafenib and 45 underwent TACE. TACE-sorafenib showed significant survival benefits compared with TACE in patients with type B (median survival, 13 months vs 6 months; P = .002) or type C (median survival, 15 months vs 10 months; P = .003) PVTT. TACE-sorafenib and main PVTT were the independent prognostic factors for survival at uni- and multivariate analysis. Liver function after TACE-sorafenib worsened only in patients with main PVTT. Sorafenib-related adverse events of grade 3 or higher occurred in 16 patients (35%).
TACE-sorafenib side effects were acceptable, and this treatment may improve overall survival in patients with HCC with first-order or lower-branch PVTT when compared with patients who underwent TACE alone.
评估经动脉化疗栓塞（TACE）联合索拉非尼（以下简称 TACE-索拉非尼）治疗肝细胞癌（HCC）合并门静脉癌栓（PVTT）患者的安全性和有效性。
本研究经机构审查委员会批准，豁免了知情同意书的要求。回顾性分析了 2010 年 1 月至 2012 年 12 月期间连续接受 TACE-索拉非尼或单纯 TACE 治疗的 HCC 合并 PVTT 患者的病历。索拉非尼（400mg）每天口服 2 次。采用 Kaplan-Meier 法根据 PVTT 类型（主门静脉 PVTT 型 A、一级门静脉分支 PVTT 型 B 和二级或更低级门静脉分支 PVTT 型 C）比较接受 TACE-索拉非尼治疗患者的结局与接受 TACE 治疗患者的结局。
91 例患者纳入分析；46 例患者接受 TACE-索拉非尼治疗，45 例患者接受 TACE 治疗。与 TACE 相比，TACE-索拉非尼在 B 型（中位生存时间，13 个月 vs 6 个月；P =.002）或 C 型（中位生存时间，15 个月 vs 10 个月；P =.003）PVTT 患者中显示出显著的生存获益。多因素分析显示，TACE-索拉非尼和主 PVTT 是生存的独立预后因素。TACE-索拉非尼后仅主 PVTT 患者的肝功能恶化。16 例（35%）患者出现 3 级或更高级别的索拉非尼相关不良事件。
TACE-索拉非尼的副作用可接受，与单纯 TACE 相比，该治疗方法可能改善 TACE 治疗后伴有一级或更低级分支 PVTT 的 HCC 患者的总生存期。
